Type 1 Diabetes

Diabetes has been known since antiquity. In 1889 Joseph von Mering and Oskar Minkowski performed animal experiments where the pancreas was removed, and discovered that the animals developed diabetes symptoms. Eleven years later, Sir Edward Albert Sharpey-Schafer discovered that diabetics were lacking a specific substance or had a reduced amount of it.

At his suggestion the substance was named insulin, from insula, the Latin word for island, because he was referring to the insulin-producing islets of Langerhans in the pancreas. In 1921 Sir Frederick Grant Banting and Charles Herbert Best repeated the 1889 experiments and were able to treat this artificially created diabetes through administering fresh extracts from the islets of Langerhans to the animals. As a result of this experiment, researchers were gradually able to refine the insulin hormone from the pancreas, thereby finding an effective treatment for the disease: insulin injections. In 1923 Banting was awarded the Nobel Prize in medicine for his discoveries. Today there is still no treatment for type 1 diabetes other than insulin.

The disease process
Type 1 diabetes is an autoimmune form of diabetes that ordinarily occurs in children and adolescents. The disease is caused by an autoimmune attack, which means that the body's own immune system destroys the insulin-producing beta cells in the pancreas.

The beta cells are gradually destroyed during a period that varies from months to several years. Symptoms only appear after this destruction has been in progress for some time. Children and adolescents with type 1 diabetes usually only come into contact with the healthcare system when their condition has become acute. At that point, only 10-20 percent of the beta cells are usually left. These are not sufficient to provide the body with enough quantities of the vital insulin. The patients must quickly receive insulin injections, which they are then forced to continue for the rest of their lives. Even after the disease is diagnosed, the autoimmune attack continues against the remaining insulin-producing beta cells, which in time will become completely destroyed. Thus the body has no capacity left to produce insulin; instead, all of its insulin needs must be met by insulin injections or an insulin pump.

No one knows today what triggers the autoimmune attack, but there are theories about different environmental factors such as viral infections. People with type 1 diabetes are also genetically predisposed for the disease, and it is possible to use genetic testing to assess the risk that an infant will develop the disease later on. About 5 percent of children with a parent or sibling with type 1 diabetes develop this type of diabetes.

An autoimmune attack in progress can be detected even before diabetes symptoms have appeared by measuring the levels of various biological markers in the bloodstream: so-called antibodies to insulin, GAD and IA2. There are presently several studies in progress which identify which children and adolescents have a high risk of developing type 1 diabetes. These studies are crucial for gaining a better understanding of the disease and being able to prophylactically treat high-risk patients, thus preventing the autoimmune attack from causing type 1 diabetes.

LIVING WITH TYPE 1 DIABETES
Type 1 diabetes is a chronic disease with a large impact on both the child and family members. Insulin must be injected and blood sugar must be measured several times a day. It is extremely important to control the disease well in order to avoid both excessively low and excessively high blood sugar levels, which can both lead to a life-threatening coma. Prolonged elevated blood sugar levels often results in serious complications as well. Therefore meals must be regulated in terms of composition and timing and balanced against the insulin dosage, which is especially difficult with younger children. It's usually a traumatic experience for the entire family when a child develops type 1 diabetes.